Anesthesia and pain medicine practices
will see some important coding changes in 2003.
These new and revised codes are a product of the
ongoing efforts of the Committee on Economics.
New Codes
Anesthesia codes are published in both the ASA Relative
Value Guide (RVG) and in the AMA’s Current
Procedural Terminology™ (CPT). For the last
couple of years, the Committee on Economics has
worked to make sure that every code adopted by ASA
is also in CPT. Table 1 shows eight anesthesia codes
that have now completed the CPT acceptance process
and will be in both the CPT and RVG books next year.
Only two codes now appear in the RVG but not CPT.
Anesthesia for open repair of pelvic acetabular
fractures, 01175, will be submitted to CPT in November
and, if approved, will appear in the 2004 book.
Daily management of patient-controlled analgesia,
01997, has been rejected twice. With these two exceptions,
the anesthesia codes in the RVG
are CPT
codes. This is important because the Health Insurance
Portability and Accountability Act of 1996 (HIPAA)
limits the code sets that will be used in electronic
claims to the official national sets such as CPT
or the Health Care Financing Administration Common
Procedure Coding System (or HCPCS, Medicare’s
system that encompasses the CPT procedural codes
and also the Medicare “Level II” modifiers,
including those for medical direction). See the
related article on page 29 for some important information
about the use of those modifiers by private payers.
New to both CPT and the RVG are codes that differentiate
between a single shot and a continuous infusion
for brachial plexus, sciatic and
femoral
nerve blocks. The continuous block codes have a
10-day global period. They include both the catheter
insertion and the subsequent daily management. Anesthesia
for vasectomies has been moved from the lower abdomen
section to the perineum section and renumbered as
new code 00921. The old code 00869 has been deleted.
Please see Table 2 for a complete listing.
Table 1 (click
to enlarge) |
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Table 2 (click
to enlarge) |
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Revised Codes
The descriptors for a number of codes have been
revised. Table 3 shows the changes through deletions
and underscoring of the text. Diagnostic arthroscopic
procedures are different than surgical arthroscopies,
and the applicable codes now reflect the distinction.
One of the thoracotomy codes (00541) henceforth
specifically applies to one-lung ventilation. The
trigger point codes will refer to the number of
muscles injected, not muscle groups. The number
of muscles involved dictates the use of either 20552
or 20553. The code for epidurolysis (62263) describes
a service encompassing multiple adhesiolysis sessions
over two or more days. New code 62264 will denote
one-day epidurolysis procedures.
Table 3 (click
to enlarge) |
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Availability of the 2003 RVG and CROSSWALK™
Thanks to the considerable efforts of Committee
on Economics members Norman A. Cohen, M.D., Annette
Fitzgerald, Jan Gillespie, M.D., Craig M. Johnson,
M.D., James P. McMichael, M.D., Stanley W. Stead,
M.D., R. Lawrence Sullivan, Jr., M.D. and Chair
Alexander A. Hannenberg, M.D., and of Sharon Merrick,
CCS-P, ASA’s Coding and Reimbursement Analyst,
the 2003 RVG and
CROSSWALK™ books
are expected to be available before the end of this
year. As always, we recommend that anesthesia practices
obtain the updated books each year because of the
steady stream of revisions and improvements.
The
tables in this article are also available in Adobe
PDF format.
HIPAA
Code Sets and Modifiers
Under the new rules set forth in the
Health Insurance Portability and Accountability
Act (HIPAA), electronic claims may include
only “standard medical code sets,”
e.g., the ICD-9 diagnostic codes, CPT codes
and Medicare’s own “HCPCS”
codes. The HCPCS codes incorporate the CPT
codes and also specific Level II codes for
clinical lab tests, medical supplies, radiology
services, and the two-character modifiers
that trigger particular payment policies.
ASA’s concern here is with the QK (medical
direction), AA (personal performance) and
AD (medical supervision) series of modifiers
that govern Medicare payments to anesthesiologists,
as well as with the GC (teaching) modifier.
Until recently, most commercial payers did
not require that claims distinguish between
personally performed or medically directed
or teaching cases. Some payers are now demanding
the Medicare Level II modifiers in order to
reduce payment to anesthesiologists, particularly
in teaching cases, as discussed in several
“Practice Management” columns
earlier this year. A purported justification
commonly given is that HIPAA requires the
use of these modifiers. HIPAA
does not (although individual payer contracts
may). In an e-mail message to
Karin Bierstein dated October 8, Gladys Wheeler,
M.A., CPC, of the HIPAA Project Staff in the
Office of Operations Management at the Centers
for Medicare & Medicaid Services, wrote
the following:
“The combination
of HCPCS and CPT-4 (including codes
and modifiers) is the HIPAA adopted
standard for reporting physician services
and other health care services on standard
transactions.
“HIPAA does not mandate the use
of modifiers. According to the adopted
HIPAA implementation guide for the ASC
X12N 837 professional claim, use of
modifiers is not required. Their usage
is “situational” meaning
that the use of a modifier is required
only when a modifier clarifies or improves
the reporting accuracy of the associated
procedure code.” |
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